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Anaesthesia 2003 Jan;58(1):73-7
Department of Anaesthetics and Intensive Care, Dumfries and Galloway Royal Infirmary, Bankend Road, Dumfries, DG1 4AP, UK.
[Medline record in process]
A questionnaire on organisation, documentation and communication of airway problems during anaesthesia was sent to 271 anaesthetic college tutors in the UK. Their responses were compared with three published recommendations. There was a 72% response rate (195/271). The recommendations of the American Society of Anaesthesiologists Task Force on the Management of the Difficult Airway were met by 71% of respondents; 2% met those suggested by the Canadian Airway Focus Group and 2% met those suggested in a standard UK textbook on difficulties in tracheal intubation. Guidelines for management of the difficult airway were available in 142 departments (73%), but only 41 (21%) had guidelines for communication and dissemination of information. We present an 'Airway Alert' scheme which has since been adopted by the Difficult Airway Society.
PMID: 12523329, UI: 22410787
Other Formats:
Ann Fr Anesth Reanim 2002 Oct;21(8):686-8
Publication Types:
PMID: 12471793, UI: 22360154
Ann Fr Anesth Reanim 2002 Oct;21(8):681-4
Departement d'anesthesie, reanimation et urgences, HIA Clermont-Tonnerre, BP 41, 29240 Brest-Naval, France. Mehdi.OA@wanadoo.fr
We report a case of central nervous system toxicity induced by ropivacaine following a brachial block at the humeral canal. Forty millilitres 0.75% ropivacaine (4.28 mg.kg-1) were used uneventfully, with slow injections and negative intermittent aspirations. Fifteen minutes later, the patient presented two episodes of generalised convulsions treated by diazepam, 20 mg. The total venous ropivacaine concentration measured two hours after the block was 2.3 mg.l-1.
PMID: 12471790, UI: 22360151
Ann Fr Anesth Reanim 2002 Oct;21(8):672-5
Service d'anesthesie-reanimation, CHU Farhat Hached, Sousse, Tunisie.
We report the anaesthetic management of a 32-year-old pregnant women with aortic dissection and Marfan syndrome for caesarean section. The patient has presented at 31 weeks gestation of a first pregnancy an aortic dissection that required an emergency aortic replacement. Three years later, she presented at 31 weeks gestation with aortic dissection, mitral valve dysfunction and acute pulmonary oedema. She was treated in intensive care unit with deslanoside, diuretic and twice a day echographic examination. Delivery was planned by caesarean section after haemodynamic stabilisation on the sixth day. Combined spinal and epidural anaesthesia was performed after monitoring. The initial intrathecal injection of bupivacaine, morphine and fentanyl provided rapid onset of analgesia. Epidural anaesthesia was used with diluted lidocaine and fentanyl boluses. With appropriate preoperative care and monitoring, uneventful combined spinal and epidural anaesthesia for Caesarean section was achieved in a patient with Marfan syndrome in the presence of aortic dissection complicated by mitral valve dysfunction and acute pulmonary oedema.
PMID: 12471788, UI: 22360149
Ann Fr Anesth Reanim 2002 Oct;21(8):668-71
Service d'anesthesie-reanimation, maternite regionale, 10, rue du Dr Heydenreich, 54042 Nancy, France. secretariat.anesthesie@maternite.chu-nancy-fr
A case of chest pain in a 31-year-old woman after vaginal delivery with epidural analgesia during sulprostone administration is described. Chest pain occurred shortly after sulprostone was started and disappeared when sulprostone was stopped. Ischaemia related data were negative. Angiographically coronary arteries were normal. Coronary artery spasm aetiology was retained. Sulprostone pharmacology is summarized. Coronary artery effects are compared with literature reports. Recommendations before sulprostone use are underlined.
PMID: 12471787, UI: 22360148
Ann Fr Anesth Reanim 2002 Oct;21(8):617-21
Service d'orthopedie, hopital d'enfants de Tunis, 1007 Tunis, Tunisie. olfa.kaabachi@rns.tn
OBJECTIVE: To evaluate the effect of intrathecal clonidine in children. STUDY DESIGN: A prospective randomised study. PATIENTS AND METHODS: 45 children, 6 to 15 years old, were randomised in two groups; receiving either 0.5% hyperbaric bupivacaine or 0.5% hyperbaric bupivacaine added to clonidine 2 micrograms.kg-1. We assessed quality and length of motor and sensory blocks and side effects of clonidine: hypotension, bradycardia and sedation. RESULTS: Clonidine was associated with prolongation of motor block. 190 +/- 42 min vs 150 +/- 35 min (p < 0.01), but the difference was not significant. Postoperative analgesia was longer in clonidine group, 490 +/- 35 min vs 200 +/- 50 min (mean +/- SD), p < 0.001. Clonidine was associated with higher incidence of hypotension 54 vs 36% and bradycardia 30 vs 0%. CONCLUSION: These data suggest that intrathecal clonidine 2 micrograms.kg-1 is associated with extending duration of postoperative analgesia but with moderate side effects.
PMID: 12471781, UI: 22360142
Br J Anaesth 2002 Dec;89(6):937-8; author reply 938
PMID: 12492107, UI: 22379503
Br J Anaesth 2002 Dec;89(6):937; author reply 938
PMID: 12453946, UI: 22340792
Br J Anaesth 2002 Dec;89(6):925-7
Service d'Anesthesie-Reanimation, Hopital de l'Hotel-Dieu, F-69002 Lyon, France.
We describe a 25 mg intrathecal morphine overdose during a combined spinal-epidural block for a Caesarean delivery. Naloxone infusion (5.24 mg over 24 h) was started prior to the patient becoming symptomatic and almost immediately after the overdose. Invasive therapeutics such as mechanical ventilation were avoided.
PMID: 12453940, UI: 22340786
Br J Anaesth 2002 Dec;89(6):922-4
Department of Anaesthesia, King Edward Memorial Hospital for Women, Bagot Road, Subiaco, WA 6008, Australia.
BACKGROUND: Infection and epidural abscess are important complications of epidural analgesia. Difficult insertion may be associated with an increased risk of bacterial contamination of the epidural needle or catheter. METHODS: Bacterial contamination of epidural needles and trocars after difficult epidural insertion, defined as two or more skin passes, was assessed in 38 obstetric and ten gynaecological patients. RESULTS: There was no bacterial growth on any of the 48 epidural needles or trocars despite the mean (range) insertion time being 20 (10-30) min and the number of insertion attempts being 3 (2-4). CONCLUSIONS: Difficult epidural insertion is not associated with an increased risk of needle contamination and is therefore an unlikely source of epidural infection.
PMID: 12453939, UI: 22340785
Br J Anaesth 2002 Dec;89(6):857-62
Departement d'Anesthesie-Reanimation, Ambroise Pare Hopital, 9 Avenue Charles de Gaulle, F-92100 Boulogne-Billancourt, France.
BACKGROUND: Beta-adrenergic agonists enhance behavioural and electroencephalographic arousal reactions. We explored whether adding esmolol, a short-acting beta(1)-adrenoceptor antagonist, to propofol anaesthesia modified the bispectral index (BIS) during induction of anaesthesia and orotracheal intubation. METHODS: Fifty patients were randomly allocated, in a double-blind fashion, to receive esmolol 1 mg kg(-1) followed by 250 micro g kg(-1) min(-1) or saline (control). Esmolol or saline was started 6 min after a target-controlled infusion (TCI) of propofol (effect-site concentration 4 micro g ml(-1)). After loss of consciousness, and before administration of vecuronium 0.1 mg kg(-1), a tourniquet was applied to one arm and inflated to 150 mm Hg greater than systolic pressure. Eleven minutes after the TCI began, the trachea was intubated; gross movement within the first min after orotracheal intubation was recorded. BIS was recorded at 10-s intervals. Mean arterial pressure (MAP) and heart rate were measured non-invasively every min. RESULTS: There were no intergroup differences in BIS, heart rate or MAP before laryngoscopy. BIS increased significantly after orotracheal intubation (compared with the pre-laryngoscopy values) in the control group only, with a maximum increase of 40 (SD 18)% vs 8 (11)% in the esmolol group (P<0.01). Maximum changes in heart rate [45 (19)% vs 23 (14)%] and MAP [62 (24)% vs 45 (23)%] with orotracheal intubation were also significantly greater in the control group than in the esmolol group. More patients in the control than in the esmolol group moved after orotracheal intubation (23 vs 12, P<0.01). CONCLUSION: Esmolol not only attenuated haemodynamic and somatic responses to laryngoscopy and orotracheal intubation, but also prevented BIS arousal reactions in patients anaesthetized with propofol.
PMID: 12453930, UI: 22340776
Br J Anaesth 2002 Dec;89(6):849-52
Department of Anaesthesiology, Istanbul University, Istanbul Medical Faculty, Capa 34390, Istanbul, Turkey. merthasta@yahoo.com
BACKGROUND: Interest in combining local and general anaesthesia has lead to studies investigating possible interactions. In a prospective, randomized, double-blind study, we tested whether local anaesthetics administered i.m. potentiate the hypnotic effect of propofol. METHODS: Sixty patients (three groups, n=20) undergoing lower abdominal surgery with total i.v. propofol anaesthesia were investigated. Patients in Group B received i.m. bupivacaine (5 mg ml(-1)) 1 mg kg(-1), patients in Group L received i.m. lidocaine (100 mg ml(-1)) 2 mg kg(-1) and patients in Group C received i.m. saline 5 ml before operation. Hypnosis was measured with bispectral index (BIS). RESULTS: The induction (BIS <45), and the maintenance doses of propofol (BIS between 40 and 50) were significantly less in Group B and Group L compared with the control group. Induction doses were 1.58 (SD 0.39), 1.56 (0.24) and 2.03 (0.33) mg kg(-1) respectively; P<0.0001. Maintenance doses were 6.33 (2.06), 7.08 (1.23) and 9.95 (2.02) mg kg(-1) respectively in the first hour; P<0.0001. Groups B and L were associated with an attenuated haemodynamic response to both induction and intubation. CONCLUSION: I.M. administered local anaesthetics are associated with a decrease in both the induction and maintenance doses of propofol during total i.v. anaesthesia and a reduction in haemodynamic responses.
PMID: 12453928, UI: 22340774
Neurosci Lett 2003 Jan 2;335(3):187-191
Departamento de Fisiologia e Farmacologia, Centro de Ciencias Biologicas, Universidade Federal de Pernambuco, 50670-901, PE, Recife, Brazil
[Record supplied by publisher]
The present study investigated the mechanisms by which intrathecal (i.t.) apomorphine affects mean aortic pressure and heart rate in anesthetized rats. In saline-pretreated rats, upper thoracic (T2-T4) i.t. administration of apomorphine (48 &mgr;g/rat) induced immediate and significant hypotension and bradycardia. These responses were unaffected by intravenous (i.v.) methylatropine (1 mg/kg) or bilateral vagotomy, while they were prevented by i.t. lidocaine (25 &mgr;l at 1%) or i.v. hexamethonium (30 mg/kg). However, i.v. atenolol (1.5 mg/kg) suppressed the apomorphine-induced bradycardia without affecting the hypotension in either intact or bivagotomized rats. Bilateral adrenalectomy had no effect upon both maximal hypotensive and bradycardic responses to apomorphine (48 &mgr;g/rat at the T9-T10 level). These results suggest that hypotensive and bradycardic responses to i.t. apomorphine are due to an action in the spinal cord, presumably on sympathetic preganglionic neurons. These responses are dissociated and seem to result from withdrawal of sympathetic outflow to the vasculature and to the heart, respectively.
PMID: 12531464
Neurosci Lett 2003 Jan 30;337(1):41-5
Department of Clinical Pharmacology, Medical Research Institute, Tokyo Medical and Dental University, 101-0062, Tokyo, Japan
Local anesthetics (LAs) block Na(+) channels with a higher affinity for the fast or slow inactivated state of the channel. Their binding to the channel may stabilize fast inactivation or induce slow inactivation. We examined the role of the LA binding sites on domain IV, S6 (IVS6) of Na(+) channels in fast and slow inactivation by studying the gating properties of the mutants on IVS6 affecting LA binding. Mutation of the putative LA binding site, F1579C, inhibited fast and slow inactivation. Mutations of another putative LA binding site, Y1586C, and IVS6 residue involved in LA access and binding, I1575C, both enhanced fast and slow inactivation. None of the mutations affected channel activation. These results suggest that the LA binding site on IVS6 is involved in slow inactivation as well as fast inactivation, and these two gatings are coupled at the binding site.
PMID: 12524167, UI: 22412398